Help with Remedial: How to Approach Situation

CadetStell

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Feb 15, 2018
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This is the following information in regard to my interactions with the DoDMERB:
22-DEC-17 Date applicant entered into DoDMERB system
22-DEC-17 Application Added
18-JAN-18 Actual date of exam
26-JAN-18 Date exam received at DoDMERB
26-JAN-18 Medical data entry
31-JAN-18 Date letter uploaded - Remedial R229.99, R251.12
31-JAN-18 Date exam reviewed
06-FEB-18 Date exam reviewed
13-FEB-18 Date exam reviewed
14-FEB-18 Date letter uploaded - Remedial R259.10, R272.00

Agency: US Air Force CSB
Cycle Year:2017
Code Description
R259.10 Applicant pending Disqualification for D226.40 - Current or history of osteochondral defect , must complete AMI(s) before waiver processing may be considered
R272.00 Obtain allergen specific IgE; quantitative or semiquantitative for: latex rubber.

How would you handle this? I am addressing the R272.00 with my primary physician (at my own cost), but where is the R259.10 heading?
Also, I just passed the PFD with the following statistics:
Push-ups: 77
Situps: 72
1.5 Run: 9:44
Score: 99.3
Should I include information on this and submit it to the DoDMERB?
 

GoCubbies

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Feb 13, 2018
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Do you have a history of some type of foot or ankle injury? You may need to be seen by an orthopedic surgeon or podiatrist as part of the info that's needed.
 

CadetStell

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Feb 15, 2018
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I had a loose body (a small piece of cartilage) present and had a left knee arthroscopy. The procedure took place more than two years ago.
 

foxtrot17

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Oct 24, 2017
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Just do as they ask and start gathering all your records regarding that problem... I had the same code 259.10... It just means that the issue is a DQ and they want to see more documents to try to clear you (the AMI they are asking is the R272.00 code, the D226.40 is the 100% sure DQ here). You could ask your Commander to seek your PT scores and react an assessment of your PT performance, for their consideration... But they will not see those extra papers until after you are DQ (D226.40 which will be happening once they get the AMI) THEY WILL DQ for sure. Once they get the Ami (R272.00) they might clear you on that specific issue or just DQ you for that too (if you don't have any current issues and the test they are asking for clears you of any current issues then they should clear it).

You can look at my posts because I went through that dilemma. But in my case I contacted Mr. Mullen (DODMERB Deputy) about the 259.10 code... He told me they send that code to accelerate the DQ process so then the waiver process can start faster... Still I wanted to send in more remedials and told me to send extra documents (more remedials) not listed originally. I offered to send some things that were not that helpful so be careful with that too! After all that, I was cleared of one thing (the Ami they were asking which was NOT a disqualifier under certain conditions) and two other issues remained as DQ's. They updated my portal from pending DQ to Disqualified and then the waiver process begins with my Detachment Commander requesting a waiver for me. Now the waiver authority which is the Air Force Air and Training command is asking for ALL MY Records regarding the issue (I waited for them to ask me since In had not sent them before). That means it's good news since they are looking for ways to qualify you. It will depend in each case and if you are in a Service Academy then a waiver will be requested automatically for you if you are deemed competitive. You can see my previous posts so you can have an idea...I have been reading a lot in here. That could help you understand each situation is different.
 
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GoCubbies

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877
Unfortunately, I can't tell you how this is going to go. Current or history of osteochondral defect is DQ.

Did your orthopedic surgeon put osteochondral defect as a diagnosis in your operative report? What I'm trying to get here is ensuring the diagnosis is true vs "overcoding" my DODMERB. If the orthopedic surgeon did put it in the operative report as a diagnosis, then it is a bona fide condition. Also, do you know if your procedure involved "microfracture" surgery?

I think the only way to help yourself is to get seen by the orthopedic surgeon and have him/her document that your symptoms have resolved, normal range of motion, no clicking or "catching" of knee, etc. The orthopedic surgery may also want to comment on the degree of defect you had. Did it involve just cartilage? I'm thinking it also involved underlying bone since DODMERB is calling it osteochondral. If so, then how much of the bone was involved? Maybe DODMERB will request another imaging study to see extent of underlying boney defect.

I'm sorry I can be more predictive of where the request is heading. I do think you will need to see an orthopedic surgeon (preferably the one who did the procedure) and he/she may order another imaging study.
 

CadetStell

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Feb 15, 2018
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@GoCubbies and foxtrot17, thank you for your advice and quick responses! I will be contacting my surgeon to get clearance documentation from him. Would it be beneficial to get a report from my High School trainer, who helped me post surgery to full activity? Additionally, do either of you think that I should notify my Detachment Commander prior to receiving the DQ case status?
 

foxtrot17

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Oct 24, 2017
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Not sure if the high school trainer note will help but I would gather it too since it would not hurt either. In my case I was asked to fill a Sports and Athletic Questionaire in addition to my Orthopedic questionaire (that last one was triggered automatically while filling my initial yes or no questionaire). I was also asked to redact my Own statements regarding my issues and my Commander was asked to chip in with a letter where he expressed his observations of me during PT (since he did oversee those operations constantly). That letter seems to be carrying a lot of weight since it was from a Lt. Col that is overseeing me so I would try to do the same through your Commander if possible BUT do not jump the chain of command...Try to go first to the Head of Personnel at your Detachment for questions...or ask DODMERB directly. It all depends if you have a good relationship with your Commander then you might go and talk to him directly...so be wary of that and BTW they should already know your status since they are supposed to receive your DODMERB status but it would not hurt to print the letter and bring it with you to the Detachment to accelerate the process. DODMERB is backlogged and the sooner the better.
 

GoCubbies

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Feb 13, 2018
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I do think it’ll be beneficial to let someone in your food chain know about this. If anything, he/she may be able to recommend additional courses of action for you.

Might be more beneficial to get the final notes from the physical therapist and orthopedic surgeon where it’s stated that you can return to full activities.
 

AFhopeful1197

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Feb 12, 2018
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We are in a similar situation. Same DQ code for osteochondral defect. My DS is an 18 yr old high school senior, 3 season competitive track and XC runner, and had some fluid accumulate around the knee in Fall of 2016 and Spring 2017. No pain, just some fluid/swelling. The orthopedic dr was perplexed, as all labs were normal (no lyme or any infectious cause). MRI showed a fissure in the cartilage behind the kneecap. He felt that that must have been the cause of the fluid and "perhaps" it was a mild osteochondral lesion. The MRI report only noted a fissuring (not OCD), but in the consult notes the orthopedic dr wrote "OCD lesion". After 2 weeks off of running it resolved and has not recurred despite 50-60 miles per week of running. So we wonder if it was the documentation of the consult note/overcoding, that led to the DQ? We are going back to see the ortho tomorrow for a re-examination, documentation of normal exam and lack of symptoms, and if the Dr feels a repeat MRI would be helpful to show it resolved, we will be doing that also. Seems so silly when he is SUPER active and no orthopedic complaints or pain of swelling...
 

CadetStell

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Feb 15, 2018
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Update on my situation for others in similar spots. This is the boat that I am in:

22-DEC-17 Date applicant entered into DoDMERB system
22-DEC-17 Application Added
18-JAN-18 Actual date of exam
26-JAN-18 Date exam received at DoDMERB
26-JAN-18 Medical data entry
31-JAN-18 Date letter uploaded - Remedial R229.99, R251.12
31-JAN-18 Date exam reviewed
06-FEB-18 Date exam reviewed
13-FEB-18 Date exam reviewed
14-FEB-18 Date letter uploaded - Remedial R259.10, R272.00
08-MAR-18 Date letter uploaded - Disqualification D226.40
08-MAR-18 Date exam reviewed
16-MAR-18 Date exam reviewed
20-MAR-18 Date letter uploaded - Remedial R259.01, R221.05, R222.31

Agency:
US Air Force CSB
Cycle Year:2017
Code Description:
R221.05 Consult with an orthopedic surgeon regarding knee - h/o Left knee with loose body removal. Please address ROM, strength, stability and if cleared for full unrestricted physical activities.
R222.31 Obtain a new MRI without contrast material of/for the Left knee to address degenerative changes, chondromalacia, and any patellar instability and forward a Board Certified Radiologist's interpretation of the MRI
R259.01 Applicant DQ - Waiver Authority requests additional information
D226.40 Current or history of osteochondral defect

I am currently getting an MRI within the next week. Hopefully, this all goes through. I am really advocating for this due to the fact of my Commander selected me as the recipient of the "Commander's Scholarship". Of course, this is contingent on my knee getting cleared, but I have not had an issue with it since surgery several years ago. Thank you for all who voiced your words of advice!
 
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